Email this article 
X-ray parameters of sagittal balance in children with multiplanar deformities of the proximal femur
- Authors: Pozdnikin I.Y.1, Bortulev P.I.1, Barsukov D.B.1, Baskov V.E.1, Baskaeva T.V.1
-
Affiliations:
- H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
- Issue: Vol 10, No 1 (2022)
- Pages: 23-32
- Section: Clinical studies
- URL: https://journals.eco-vector.com/turner/article/view/88912
- DOI: https://doi.org/10.17816/PTORS88912
Cite item
Full Text
Open Access
Access granted
Subscription or Fee Access
Abstract
BACKGROUND: Multiplanar deformities of the proximal femur in children are often accompanied by a high position of the greater trochanter, causing disturbances in the biomechanics of the hip joint and extra-articular impingement syndrome. Progressive anatomical and biomechanical changes in multiplanar deformities of the proximal femur also lead to changes in the system hip joints, the pelvis, and the lumbosacral spine that mutually burden each other. Currently, the domestic literature has isolated publications on assessing the state of sagittal vertebral-pelvic ratios in children with this pathology.
AIM: This study assesses the radiological parameters of sagittal balance in children with multiplanar deformities of the proximal femur with a high position of the greater trochanter. It reveals the relationship between the deformity severity of the proximal femur and spinal and pelvic parameter changes in children.
MATERIALS AND METHODS: The x-ray data of examination of 25 children (25 affected joints) aged from 9 to 15 years with deformities of the proximal femur with a high position of the greater trochanter, in which its apex is located at or above the upper pole of the femoral head, were analyzed. The parameters characterizing the ratio of the femoral head to the greater trochanter in the frontal plane and indicators of the sagittal balance according to lateral skeleton radiographs were evaluated. The obtained data were subjected to statistical processing.
RESULTS: Children with multiplanar deformities of the proximal femur with a high position of the greater trochanter are characterized by a pronounced increase in global lumbar lordosis, excessive pelvic anteversion, and the pelvic tilt toward the affected limb. A direct relationship was found between the severity of the proximal femur disorders and the degree of change in the sagittal spinal-pelvic ratio indices.
CONCLUSIONS: The combination and progression of anatomical changes in the hip joints in children with a high position of the greater trochanter cause pathological compensatory changes in the lumbosacral spine with degenerative dystrophic processes development.
Full Text
About the authors
Ivan Yu. Pozdnikin
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Author for correspondence.
Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
SPIN-code: 3744-8613
MD, PhD, Cand. Sci. (Med.)
Russian Federation, Saint PetersburgPavel I. Bortulev
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
SPIN-code: 9903-6861
MD, PhD, Cand. Sci. (Med.)
Russian Federation, Saint PetersburgDmitry B. Barsukov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
SPIN-code: 2454-6548
MD, PhD, Cand. Sci. (Med.)
Russian Federation, Saint PetersburgVladimir E. Baskov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: dr.baskov@mail.ru
ORCID iD: 0000-0003-0647-412X
SPIN-code: 1071-4570
MD, PhD, Cand. Sci. (Med.)
Russian Federation, Saint PetersburgTamila V. Baskaeva
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434
SPIN-code: 5487-4230
MD, orthopedic and trauma surgeon
Russian Federation, Saint PetersburgReferences
- Sokolovskii OA, Koval’chuk OV, Sokolovskii AM, et al. Formirovanie deformatsii proksimal’nogo otdela bedra posle avaskulyarnogo nekroza golovki u detei. Novosti khirurgii. 2009;17(4):78–91. (In Russ.)
- Schneidmueller D, Carstens C, Thomsen M. Surgical treatment of overgrowth of the greater trochanter in children and adolescents. J Pediatr Orthop. 2006;26(4):486–490. doi: 10.1097/01.bpo.0000226281.01202.94
- Pozdnikin IJu, Baskov VE, Barsukov DB, et al. Gipertrofija bol’shogo vertela i vertel’no-tazovyj impindzhment-sindrom u detej (prichiny formirovanija, rentgenoanatomicheskaja harakteristika). Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2019;7(3)15–24. (In Russ.). doi: 10.17816/PTORS7315-24
- Bortulyov PI, Vissarionov SV, Baskov VE, et al. Ocenka sostoyaniya pozvonochno-tazovyh sootnoshenij u detej s dvustoronnim vysokim stoyaniem bol’shogo vertela. Sovremennye problemy nauki i obrazovaniya. 2020;(1)66. (In Russ.)
- De Sa D, Alradwan H, Cargnelli S, et al. Extra-articular hip impingement: A systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery/ 2014;30(8):1026–1041. doi: 10.1016/j.arthro.2014.02.042
- Bardakos NV. Hip impingement: beyond femoroacetabular. Journal of Hip Preservation Surgery. 2015;2(3):206–223. doi: 10.1093/jhps/hnv049
- Kelikian AS, Tachdjian MO, Askew MJ, Jasty M. Greater trochanteric advancement of the proximal femur: a clinical and biomechanical study. The Hip. 1983;77–105.
- Stevens PM, Coleman SS. Coxa breva: its pathogenesis and a rationale for its management. J Pediatr Orthop. 1985;5:515–521.
- Krasnov AI. Mnogoploskostnye deformatsii proksimal’nogo otdela bedrennoi kosti u detei i podrostkov posle konservativnogo lecheniya vrozhdennogo vyvikha bedra (diagnostika, lechenie). Travmatologiya i ortopediya Rossii. 2002;(3):80–83. (In Russ.)
- Bortulev PI, Vissarionov SV, Baskov VE, et al. Ocenka sostoyaniya pozvonochno-tazovyh sootnoshenij u detej s dvustoronnim vysokim stoyaniem bol’shogo vertela. Sovremennye problemy nauki i obrazovaniya. 2020;(1):66. (In Russ.). doi: 10.21823/2311-2905-2018-24-3-74-82
- Xominecz VV, Kudyashev AL, Shapovalov VM, Miroevskij FV. Sovremennye podxody k diagnostike sochetannoj degenerativno-distroficheskoj patologii tazobedrennogo sustava i pozvonochnika. Travmatologiya i ortopediya Rossii. 2014;(4):16–26. (In Russ.)
- McCarthy JJ, Weiner DS. Greater trochanteric epiphysiodesis. International Orthopaedics. 2008;32(4):531–534. doi: 10.1007/s00264-007-0346-5
- Hesarikia H, Rahimnia A. Differences between male and female sagittal spinopelvic parameters and alignment in asymptomatic pediatric and young adults. Minerva Ortopedica e traumatological. 2018;69(2):44–48. doi: 10.23736/S0394-3410.18.03867-5
- Weinstein S, Mubarak SJ, Wenger DR. Developmental hip dysplasia and dislocation: Part II. Instr Course Lect. 2004;(53):531–542.
- Bombelli R, Santore RF, Poss R. Mechanics of the normal and osteoarthritic hip. A new perspective. Clin Orthop. 1984;182:69–78.
- Chaudhry H, Ayeni OR. The etiology of femoroacetabular impingement. Sports Health: A Multidisciplinary Approach. 2014;6(2):157–161. doi: 10.1177/1941738114521576
- Macnicol MF, Makris D. Distal transfer of the greater trochanter. J Bone Joint Surg Br. 1991;73:838–841. doi: 10.1302/0301-620X.73B5.1894678
- Leunig M, Ganz R. Relative neck lengthening and intracapital osteotomy for severe Perthes and Perthes-like deformities. Bull NYU Hosp Jt Dis. 2011;69 (Suppl 1):S62–67.
- Prodan AI, Radchenko VA, Khvisyuk AN, Kutsenko VA. Mechanism of vertical posture formation and parameters of sagittal spinopelvic balance in patients with chronic low back pain and sciatica. Khirurgiya pozvonochnika [Spine surgery]. 2006;(4):61–69. (In Russ.). doi: 10.14531/ss2006.4.61-69
- Fukushima K, Miyagi M, Inoue G, et al. Relationship between spinal sagittal alignment and acetabular coverage: a patient-matched control study. Archives of Orthopaedic and Trauma Surgery. 2018;138:1495–1499. doi: 10.1007/s00402-018-2992-z
- Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011;20 Suppl 5(Suppl 5):609–618. doi: 10.1007/s00586-011-1928-x
- Le Huec JC, Rossouly P. Sagittal spino-pelvic balance is a crucial analysis for normal and degenerative spine. Eur Spine J. 2011;20(5):556–557. doi: 10.1007/s00586-011-1943-y
- Abelin K, Vialle R, Lenoir T, et al. The sagittal balance of the spine in children and adolescents with osteogenesis imperfecta. Eur Spine J. 2008;17(12):1697–1704. doi: 10.1007/s00586-008-0793-8
- Prudnikova OG, Aranovich AM. Clinical and radiological aspects of the sagittal balance of the spine in children with achondroplasia. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2018;(6) 4:6–12. (In Russ.). doi: 10.17816/PTORS646-12
- Ozer AF, Kaner T, Bozdoğan Ç. Sagittal Balance in the Spine. Turkish Neurosurgery. 2014;24(1):13–19.
- Zheng X, Chaudhari R, Wu C, et al. Repeatability test of C7 plumb line and gravity line on asymptomatic volunteers using an optical measurement technique. Spine. 2010;35(18):E889–E894. doi: 10.1097/brs.0b013e3181db7432
Supplementary files
